Distribuição e custo de antimicrobianos na Atenção Primária

Abstract

Objective: To analyze antimicrobial distribution and costs in primary care of a capital city in the Northeast region of Brazil. Methods: Cross-sectional, analytical study, developed in the city of Teresina, in the state of Piauí, Brazil. Data cover the period from June 2015 to July 2016. Descriptive statistics and the Kruskal-Wallis test were calculated to compare the medians of the independent data distributions. Results: A total of 1,651,516 antimicrobials were distributed in 15 different types, with amoxicillin (500mg) being the most distributed (75%) in psychosocial care centers, and in the basic health units (47%). The total cost for the period was 98,705.00 BRL. There were no statistically signifi cant differences among the costs medians in each zone of the studied municipality. Conclusion: These drugs are irregularly distributed among the units, according to the demand. The supply does not follow a specifi c protocol, and a possible increase or reduction in demand is not investigated. ResumoObjetivo: Analisar a distribuição e custos de antimicrobianos na Atenção Primária de uma capital da Região Nordeste do Brasil. Método: Estudo transversal, analítico, desenvolvido em Teresina, Piauí, Brasil. Os dados contemplam o período de junho de 2015 a julho de 2016. Calculou-se estatísticas descritivas e o Teste de Kruskal-Wallis para comparar as medianas das distribuições de dados independentes. Resultados: Foram distribuídos 1.651.516 antimicrobianos de 15 tipos diferentes dos quais a amoxicilina (500mg) foi o mais distribuído (75%) nos Centros de Atenção Psicossocial e nas Unidades Básicas de Saúde (47%). O custo total no período foi de 98.705,00 reais. Não houve diferenças estatisticamente signifi cante entre as medianas dos custos em cada zona do município estudado. Conclusão: A distribuição desses medicamentos é realizada de forma irregular entre as unidades, de acordo com a demanda. O fornecimento não segue protocolo específi co, e não se investiga um possível aumento na demanda ou redução. ResumenObjetivo: Analizar la distribución y costos de antimicrobianos en Atención Primaria de una capital del Noreste de Brasil. Método: Estudio transversal, analítico, desarrollado en Teresina, Piauí, Brasil. Datos obtenidos entre junio de 2015 y julio de 2016. Se aplicó estadística descriptiva y el Test de Kruskal-Wallis para comparar las medianas de las distribuciones de datos independientes. Resultados: Fueron distribuidos 1.651.516 antimicrobianos de 15 tipos diferentes, de los cuales la amoxicilina (500mg) fue el más entregado (75%) en Centros de Atención Psicosocial y en Unidades Básicas de Salud (47%). El costo total durante el período fue de 98.705,00 Reales. No hubo diferencia estadísticamente signifi cativa entre las medianas de costos en cada zona del municipio estudiado. Conclusión: La distribución de estos medicamentos se realiza de manera irregular entre las unidades, de acuerdo a la demanda. La provisión no cumple protocolos específi cos, y no se investiga un posible aumento o reducción de demanda.

Factors related to infection by klebsiella pneumoniae in a private hospital / Fatores relacionados a infecçao por klebsiella pneumoniae em um hospital privado

“…Bacterial resistance is a method that results from some events, such as: indiscriminate use of antibiotics and change in bacterial genes, which conclude in structural changes in bacterial cells. [4][5][6][7][8] The most resistant antibiotics were piperacillin/ tazobactam 52 (82.5%), cefixime 44 (69.8), streptomycin 39 (63.9), cefepime 36 (64. Antibiotic resistance may decrease by rational use, taking into account the pharmacological properties of antimicrobials, such as pharmacokinetics and pharmacodynamics, as well as diagnostic tests and antimicrobial susceptibility tests.…”

“…11 The increasing diversity of the mechanisms of resistance and a high percentage of Klebsiella pneumoniae resulted in a reliance on the use of carbapenemic antimicrobials, which are considered the last therapeutic option available for the treatment of serious infections, a fact that has contributed to the increase in the prevalence of KPC, and has been associated with an increase in the cost and length of patient stay in the hospital, often leading to a lack of processing, resulting in complication of the clinical picture, and death. 4,12 This theme has aroused great concern in hospitals and health institutions, as Klebsiellas pneumoniaes carbapenemases are increasingly present in hospital infections. In this study, deaths due to KPC infection were recorded.…”

“…15 To reduce these high rates and mortality, it is necessary that the hospital adopt preventive measures, such as: establish contact precautions in patients with suspicion, confirmation of infection or colonization by multidrugresistant microorganisms, make the correct use of PPE and follow the recommendations of the precautions, make swab culture in conscious patients and put contact precautions until the result of the examinations, make the use of materials and equipment exclusive (sphygmomanometer, thermometer, stethoscope). 2,4,[8][9][10] Talk about cleaning care using soap and water and disinfection with alcohol 70% of the surfaces and materials that come into contact with the patient, as recommended by the CCIH. Emphasize the rational use of antimicrobial by physicians.…”

“…1,2 This microorganism is one of the most common hospital pathogens presenting an increasingly restricted vulnerability profile, associated not only with infection, but also with colonization. 3,4 Infection acquired in the hospital environment is one of the most severe complications for exacerbation of a patient's state of health. The longer the patient is hospitalized, the greater the risk that the patient will be affected by an infection.…”

Análise de prescrições de antimicrobianos na Atenção Primária à Saúde

“…The UBS are subdivided into zones, namely: the east/ southeast area, which comprises 36 UBS; the northern zone, with 25 UBS; and the south zone, with 27 UBS. CAPS are referral and treatment centers for people with psychological distress and are divided into three models, each with its own particularities: 4 (four) CAPS II; 1 (one) CAPS III; 1 (one) CAPS AD (alcohol and drugs); and 1 (one) CAPS i (6) . Data were collected from January to March 2017.…”